Department of Veterans Affairs s19

Department of Veterans Affairs (VA) Pathology and Laboratory Medicine Service (P&LMS)

Report to the Intersociety Pathology Council (IPC) Sunday, March 7, 2009

Fred H. Rodriguez, Jr., MD VA Representative to the IPC

The VA Pathology and Laboratory Medicine Service continues to provide high quality services to support patient care in the nation’s largest integrated healthcare system. All of the laboratories in the VA continue to be fully accredited by external inspection agencies. Many VA laboratories continue to provide valuable training experiences for both resident physicians and non-physician laboratorians through affiliation agreements. VA pathologists continue to provide high quality diagnostic, educational, and research services.

During the last year, there have been changes in the VA leadership. Dr. William Triest, of the Huntington, West Virginia, VA Medical Center, was selected as the new VA National Director of the Pathology and Laboratory Medicine Service replacing Dr. Fred Rodriguez, Jr. Also, Retired Army Gen. Eric K. Shinseki was confirmed as the new Secretary for the VA. He is charged with a vision to transform VA into an organization that is people-centric, results-driven and forward- looking. Key issues on his agenda include leveraging information technology to accelerate and modernize services, and opening VA’s health care system to Veterans previously unable to enroll in it, while facilitating access for returning Iraq and Afghanistan Veterans. With the new administration, other key leadership positions in the VA are also under recruitment.

There are a number of significant projects that involve the VA P&LMS. Information technology issues continue to dominant.

 The Laboratory System Re-engineering Initiative: This project continues to progress. The prototype sites described last year are conducting further user acceptance testing with the expectation of going “live” later in 2009. An innovative module for enhanced reporting complex results (e.g. molecular diagnostic testing and genetic testing) is under development. It is hoped that national deployment of the new program can begin in 2010.

 The Bar Code Expansion Project (BCE): This project to add functionalities for labeling of lab specimens, blood component administration, vital signs, enhancement of medication administration, and read access to the patient’s electronic medical record (i.e. CPRS) using wireless technology at the patient’s bedside remains stalled It awaits the award of a new contract for scanners to be followed by interface development. A date for reactivation has not been set. Other national VA IT projects impacted the priority of the BCE project.

 The Methicillin Resistant Staphlococcus aureus Prevention Program: This program has been implemented at all VAs. Rapid PCR technology has been implemented at over two thirds of VA clinical labs. The Pathology Service is developing software to capture patient data to facilitate a national roll-up of results. A key element will be standardization of nomenclature and data files.

 The Armed Forces Institute of Pathology (AFIP): While the Base Realignment and Closure Act of 2005 included the “disestablishment” of the AFIP by 2010, the Defense Authorization Act of 2008 mandated the establishment of a federal “Joint Pathology Center” (JPC). The new JPC will be based at the new Walter Reed National Military Medical Center in Bethesda, MD. The “command structure” of the JPC is still under discussion within the Department of Defense. The JPC will provide many of the services the AFIP provided including consultation. education, research, and maintenance of the Tissue Repositories. The JPC will be the federal government’s premier pathology reference center for all federal agencies (including the VA). Multiple specific details of the JPC remain to be resolved, but the goal is to be active by 2010 when the AFIP is “disestablished”.

 Laboratory Education: VA P&LMS is seeking to expand the role of the VA in the training of laboratorians (i.e. medical technologists, clinical laboratory scientists). A new committee has been formed to consider national expansion of a current regional program. The pilot, regional, model program utilizes online “distance learning” for didactic courses, with experiential laboratory training at the sponsoring VA laboratory. Other aspects of this program include compilation of a users manual drawn from existing VA affiliated training programs, expansion of funding for students, and exploration of a possible career leader approach with multiple entry points.

 Blood Utilization Review: A working group has been formed to review utilization review criteria for blood components with a hoped for outcome that consensus criteria can be developed for use by local Transfusion Review Committees. Having uniform review criteria would reduce the variation in review criteria currently occurring at each local VA facility, and improve blood component utilization across the system.

 Reducing laboratory specimen identification errors: A VHA Directive regarding data collection on mislabeled lab specimens is in the concurrence process. This Directive will require each VA laboratory to collect and report data for various types of specimen mislabeling errors in a standardized manner. Since specimen mislabeling is a significant patient safety issue, compliance with this Directive will directly support the patient safety initiatives of several accrediting agencies including the Joint Commission, the College of American Pathologists, and others. The database generated by this data collection will drive policy and procedure changes to improve patient safety.

 Affiliation agreements and pathology residency training: I am not aware of any substantial changes to the existing allocation of pathology residency training positions at VA sites or the support for these positions.

 Enhanced stringency of VA policies regarding “cyber” security, protection of patient privacy, and verification of credentials of VA providers continues (e.g. insertion of a non-VA “thumb” drive into the USB port of a VA computer will “lock out” the computer from the VA network and send a security breach notice to the VA information security officer). IT security violations can result in disciplinary action.

While there are various other issues and programs that are the responsibility of the VA P&LMS, this brief synopsis highlights a few of the key projects.